2018 July Netball4Life Clinic Rego Form
PARTICIPANT DETAILS
Name of Child/Ward *
Your answer
Date of Birth *
Your answer
Playing Level
e.g. club/grade, beginner, rep squad
Your answer
Do you have a friend you wish to be paired with?
Your answer
Clinic Date(s) *
Please tick all that are appropriate (you may book in to more than 1 clinic). If the clinic you want to book in for does not appear then it is BOOKED OUT! General Clinics cover all the foundation skills of netball including footwork, ball skills, attacking, defending and shooting. Learn to Play Clinics are for children aged 5-6yrs only.
Required
MEDICAL INFORMATION
The medical information you provide will only be used in the event of injury, illness or emergency, if required.
Medicare No *
Your answer
Ambulance Member *
Private Health Insurance *
Existing Medical Conditions/Injuries/Allergies
Please provide details below.
Your answer
Regular Medication
Please provide details below
Your answer
EMERGENCY CONTACTS
Please provide the following contact details for two emergency contacts.
Emergency Contact 1 (Name) *
Your answer
Emergency Contact 1 (Landline Phone Number) *
Home or office.
Your answer
Emergency Contact 1 (Mobile Number) *
Your answer
Emergency Contact 2 (Name) *
Your answer
Emergency Contact 2 (Landline Phone Number) *
Home or office.
Your answer
Emergency Contact 2 (Mobile Number) *
Your answer
Parent/Guardian Details
Parent/Guardian Name *
Your answer
Address *
Your answer
City/Suburb *
Your answer
Postcode *
Your answer
Home Phone *
Your answer
Mobile *
Your answer
Email *
Your answer
Email *
Please enter again for authentication purposes.
Your answer
TERMS AND CONDITIONS
MEDICAL TREATMENT CONSENT: I understand that netball is a limited contact sport and that there is a risk of injury involved in participating in netball related activities. I authorise any official from Netball4Life, in the event of any injury or illness, to obtain on my child’s/ward’s behalf and at my expense any medical assistance, treatment and transportation as deemed necessary.

IMDEMNITY: Except where provided or required by law and such cannot be excluded, I agree that Netball4Life and its respective directors, officers, members, servants or agents are absolved from all liability however arising from injury or damage to my child/ward, however caused, arising whilst participating in any Netball4Life activity.

IMAGE CONSENT: I provide consent for Netball4Life to record my child’s/ward’s image (photograph or video footage) for promotional purposes. I understand my child’s/ward’s image may be used in mediums including: publications and promotional material, and broadcast, print and electronic media. I acknowledge that my child’s/ward’s image will be used without any personal compensation or remuneration. I agree to forgo any rights to my child’s/ward’s image including moral rights and copyright.

PERSONAL INFORMATION: I understand my personal information will be used for management and registration purposes. I understand my personal information will be kept on file by Netball4Life and occasionally Netball4Life may send me promotional material. Netball4Life won’t divulge any of my personal information to a third party.

REGISTRATION INFORMATION: Once your booking registration form has been received and payment has been completed you will be sent an invoice and a registration confirmation to the email address provided. All bookings must be paid for 7 days prior to attending the clinic to confirm registration. Netball4Life has a 48hr cancellation policy. Cancellations received outside of 48 hours of the clinic date will be eligible for a full refund. Cancellations received within 48 hours of the clinic date will only be eligible for a 50% refund. In the event of injury or illness (and on presentation of a medical certificate) you will be refunded your full registration fee. Substitutions are allowed as long as we are notified by email of the change (info@netball4life.com).
Declaration *
I have read, understood and agree to the above terms and conditions and I personally consent to the application of my child. I warrant that all information provided is true and correct.
PAYMENT INFORMATION
Registration for all school holiday clinics costs $42 per child for the 7-14yr clinics and $30 per child for the 5-6yr clinics. Payment is required 7 days before the clinic date in order to guarantee your spot.
Payment Options *
We accept payment via paypal and bank transfer. If neither of these payment options are open to you please contact Netball4Life on 0407 415 969 to discuss alternative payment options.
Required
Netball4Life Contact Information
Phone: (02) 4975 1276
Fax: (02) 4365 5833
Email: info@netball4life.com
Mail: 10 Ruislip Parkway, Buttaba NSW 2283
Web: http://www.netball4life.com
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